Parkinsons Physical Therapy Exercises Improve Balance Coordination Strength
Parkinsons Disease has a wide range of symptoms that generally begin with tremor, stiffness, and slowing of movement. As the disease progresses, PD motor symptoms can include foot-dragging, freezing, less-pronounced movements, and facial expression. Treating Parkinsons with physical therapy is recommended to reduce stiffness and discomfort and to allow patients to continue to perform daily tasks and retain independence.
Parkinsons physical therapy should be the first medicine in the treatment of PD. Properly trained physical therapists can address issues beyond just the conditions motor symptoms. Specific exercises targeting PD can have a large impact, and PD experts agree that physical activity is beneficial to PD patients at all stages of their disease, including at early diagnosis. Physical therapists trained in treating neurological conditions recommend exercises for people with PD aimed at improved balance and coordination, flexibility, endurance, and strength.
Researchers have found that during Parkinsons physical therapy, the frequency of a workout is more important than the type of exercise a patient engages in. In fact, patients who exercise at least 2-1/2 hours per week experience a slower decline in quality of life.
Each person with PD is affected differently, and specialists in Parkinsons treatments should take an individualized approach to managing the disorder. Read on for our Physical Therapy for PD Q & A.
How Does Physical Therapy Help Parkinson’s Disease
Physical therapy cannot cure Parkinson’s disease, because at this time, neurological damage cannot be reversed. But therapy can help you compensate for the changes brought about by the condition. These “compensatory treatments,” as they’re called, include learning about new movement techniques, strategies, and equipment. A physical therapist can teach you exercises to strengthen and loosen muscles. Many of these exercises can be performed at home. The goal of physical therapy is to improve your independence and quality of life by improving movement and function and relieving pain.
Physical therapy can help with:
- Balance problems
- Immobility
- Weakness
Important note: Some physical therapists may apply diathermy to relieve muscle aches and pains. This could be dangerous to patients who have deep brain stimulators.
Among Benefits Lesser Reliance On Pharmaceutical Treatments
Results showed that LEDs significantly decreased with a long-term rehabilitation or exercise program, indicating patients were generally able to lower their medication doses.
A subgroup analysis of each exercise type found that no individual exercise led to significant motor gains when anti-parkinsonian medications were not being used. Only resistance training was associated with motor improvements in the absence of medications, and it was the finding of a single study.
Multidisciplinary rehabilitation, which mainly consisted of physical therapy with some visual and auditory guidance training to improve gait and posture, was linked to improvements in daily life activities and a reduction in LED.
The researchers suggested that a multidisciplinary approach has more treatment modes and improves the functional impairment of the patients more widely, which could account for daily life gains not seen with other approaches. But they noted that a small number of studies for each intervention type limits their analyses.
Still, overall findings support that at least six months of physical therapy for people with mild-to-moderate Parkinsons could effectively improve the motor symptoms of patients whether combined with antiparkinson drug therapy or not, the researchers wrote.
Such gains boost the confidence of Parkinsons patients and make them pay more attention to and adhere to long-term physical therapy, they added.
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Common Physical Therapy Goals
As a physical therapy patient, you will work with a physical therapist to set and achieve realistic goals. A physical therapist will create a tailored, research-based exercise routine for you. They will first evaluate your current abilities and consider the areas you want to improve. The therapist will then design an exercise program to target those areas. Typically, physical therapy involves small achievements that build to a bigger goal.
Although your physical therapist will create an exercise plan based on your unique needs, shared goals for patients with Parkinson’s disease include:
Good Days And Bad Days
Parkinsons symptoms fluctuate. Some days, the patient will be able to move quickly, smoothly, and confidently, like their old self has returned. Other days, they will hardly be able to move, eat, or talk. It is a seesaw and the only way to cope is to approach each day as its own. Determine where you are and make it work as best you can. If it is a bad day, focus on rest and recovery, knowing you will be ready to take advantage of good days when they come.
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Why Big Is Better
BIG has one primary focus: amplitude. It asks those following the program to move big, encouraging a vigorous range of movement and pushing participants to use all parts of the body, from the feet to the hands and fingers. In a BIG session, the patient mimics or mirrors the therapist through a series of large stepping or rocking movements with their arms moving in various directions.
In recent studies, the principles of LSVT BIG were applied to limb movement in people with Parkinsons disease. The documented results demonstrated improvements in amplitude that generalized to improve speed , balance, and quality of life. In addition, people were able to maintain these improvements when challenged with a dual task.
At Progressive Physical Therapy, our programs are designed to meet the individual needs of the patient and their ability in a safe and fun manner. This, combined with doing a home exercise program one to two times a day helps clients with Parkinsons Disease improve their skills. The goal is for patients to use their bigger movements automatically in everyday living and for long-term carryover of increased amplitude. The therapy can be used in a walking, standing or sitting position.
Wellbeing Parkinsons Disease And Physical Therapy
Quality of life is the overriding concern of Parkinsons disease and physical therapy. Though patients cannot reverse their symptoms, with the help of their therapist, they can remain independent and functional. By moving and staying active, they can make good days more productive and bad days less challenging.
Sadly, no amount of physical therapy can reverse Parkinsons disease. Eventually, there will come a time when the patient cannot maintain their independence and will require someone to look after them full-time. Despite this, physical therapy still plays a useful role by reducing the burden of care.
Therapists can help patients re-learn basic physical skills, such as rolling over or raising their arms. Simple movements can make the patient more of a partner, able to assist their caregiver with the activities of daily living such as bathing, grooming, and dressing, improving outcomes for both caregiver and patient alike.
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How Can Occupational Therapy Help Parkinson’s Disease
For Parkinson’s disease, occupational therapy generally provides assessment, treatment, and recommendations in the following areas:
- Arm and hand therapy
- Driver evaluation and vehicle modification information
- Cooking and homemaking adaptations
- Ways to make the most of your energy
- Computer modifications
- Workplace or work equipment modifications
- Leisure skill development
Can Physical Therapist Intervention Help This Patient
Mr Jennings, a 54-year-old financial planner currently in H& Y stage 2, had been diagnosed with PD 4 years earlier. His symptoms had begun 7 years earlier with weakness and tremor on his left side. He had not received physical therapist for PD. Medications and supplements included pramipexole, selegiline, amantadine, coenzyme Q10, a multivitamin, and fish oil containing omega-3 fatty acids. He had no significant comorbid conditions. His goal was to engage in a therapeutic exercise program to prevent decline related to aging and PD. Mr Jennings did not report any falls but reported feeling stiff, moving slowly, and being concerned about balance and walking, particularly in crowded environments.
The physical therapist evaluation included measures of function and an assessment of underlying impairments that could limit current or future abilities with balance and gait. Several of these measures, including the TUG, the FRT, and the 6-minute walk test, were reported in the Cochrane review. Additional measures of balance and gait included the Five-Times Sit-to-Stand Test and the Functional Gait Assessment . His score of 25 of 30 on the FGA indicated a mild fall risk . He was able to ascend and descend a full flight of stairs without the use of a railing, indicating good lower extremity strength. This finding was further confirmed by his ability to perform the FTSST in 10 seconds and without the use of hands.
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Occupational Therapy For Parkinsons Disease
Occupational therapy for Parkinsons Disease incorporates the use of functional activities as part of the therapy process, including:
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ADL training: dressing, feeding, bathing, grooming, hygiene, toileting
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IADL training: leisure activities, social participation, caring for pets, participating in daily activities and routines
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Balance training to improve participation in tasks
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Training to manage tremors in the hands and upper extremities
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Safety and fall prevention including fall proofing of home environments
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Modification of tasks including recommendation of equipment, technology and adaptive strategies to improve independence
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Transfer training to improve ability to get up from a chair or toilet seat as well as in and out of bed or a car.
An occupational therapy program can help a client with Parkinsons Disease to:
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Prevent falls and improve safety at home
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Improve coordination with tasks including buttoning, feeding and handwriting
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Manage tremors during functional tasks
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Continue to participate in social activities with modifications
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Maintain independence at home with improved safety
The Importance Of Physical Therapy For Parkinsons
Since Parkinsons disease causes such an impact on the body, physical therapy can make a big difference. Even though the nerve damage caused by the disease cant be reversed, you can improve your physical capacity and learn how to compensate for impairments.
Working with a physical therapist can help improve your balance, your gait, and your daily movements, among other skills. You can also build strength and cardiovascular capacity with aerobic and strength training.
Early on, your physical therapist can help you maintain your current functioning and favorite activities. In later stages, the therapist can help you relearn how to perform your daily activities or work around the changes in your body.
One of the main goals of physical therapy for Parkinsons disease is to enhance your wellbeing through timely interventions and education. You should feel better as a result of the benefits of physical therapy, which include:
- Pain relief
- More energy
- Improved strength
Therapeutic interventions help you stay active and maintain your independence. Without physical therapy, you risk greater disability, more fall risk, worsening physical ability, and poorer quality of life.
Early intervention is particularly imperative as you have a vital window to address issues early on, even before you notice changes. Your physical therapy sessions are a critical part of your care.
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Physical Therapy For Parkinsons
Physical therapy is a program that helps you build strength, flexibility, balance, and coordination. It starts with an evaluation of your current abilities to locate the areas of movement causing you problems.
The therapist will teach you exercises and other techniques to improve your strength, coordination, balance, and movement. During physical therapy sessions, you might learn to:
- get in and out of bed or a chair more easily
- stretch your muscles to improve your range of motion
- avoid a fall
- walk more smoothly, without shuffling
- go up and down stairs
- use a cane or a walker to help you get around
To get the most out of your physical therapy sessions, find a therapist with experience treating Parkinsons or similar disorders. Therapists who are board-certified neurologic specialists should have this type of training. Ask your neurologist to recommend someone.
Certain types of physical therapy can help with movement issues caused by Parkinsons disease. Here are a few of them.
Physical Therapy For Parkinson’s Disease
If you have been diagnosed with Parkinson’s disease your healthcare provider may refer you to many specialists to help you move and function better. A physical therapist is a movement specialist who can assess and treat the motor control and planning changes that occur with the disease.
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How Did The Physical Therapist Apply The Results Of The Cochrane Review To Mr Jennings
Mr Jennings’ physical therapist posed the following question: Will a physical therapist program improve the physical functioning of a 54-year-old man in H& Y stage 2 of PD? Findings from the Cochrane systematic review completed by Tomlinson et al were applied by use of the patient-intervention-comparison-outcome approach, as follows.
Patient
The review included people in H& Y stages 1 to 4 of PD, with a mean age of 67 years, and 6 years after diagnosis. Mr Jennings was in H& Y stage 2, was younger than the mean age , and had been diagnosed 4 years earlier. Thus, Mr Jennings fit the overall criteria but was younger and had had the diagnosis for a time shorter than the mean time for the people in the studies reported in the review.
Intervention
Comparison and alternate approaches
Outcome
The review indicated that all interventions, including general physical therapy and exercise, resulted in small, short-term beneficial changes in gait, balance, or functional mobility measures for people with PD. Some of the outcome measures used for Mr Jennings were consistent with those reported in the review.
Pedaling For Parkinsons Viewed Favorably By Patients In Study
Despite disease-relevant treatments, Parkinsons patients experience declines in physical functioning and their capacity to participate in daily activities as their disease progresses.
Adding physical therapy to medication regimens is a common approach to help slow these declines. Physical therapy can encompass a range of activities, with most programs involving Parkinsons-relevant exercises to build muscle strength, improve balance, and restore or retain a more normal posture and gait, all with the goal of improving or maintaining functional abilities.
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Emotional And Physical Impact
Disease duration in those diagnosed with PD can span decades. Due to the progressive nature of the disease, there is considerable emotional, social, and physical impact. These impacts include compromised functional status and quality of life, social isolation due to the presence and severity of motor and nonmotor symptoms, and increased burden on care partners.
Parkinsons Disease And Physical Therapy
Nearly one million people in the U.S. are currently living with Parkinsons disease, making it the second most common neurodegenerative disease. Symptoms often begin around age 60 years, but can occur earlier. Since these symptoms include shaking, stiffening, slow movements, and difficulty with balancing, physical therapy can be an effective treatment to help patients manage symptoms.
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What Can Be Advised Based On The Results Of This Systematic Review
Findings from the systematic review demonstrated that people with PD achieve greater short-term improvements in gait and balance with physical therapy intervention than with placebo or no physical therapy intervention. Because PD is a progressive condition, short-term benefits are important, but true benefits may be realized only if the patient develops the skills and strategies for long-term adherence to appropriate exercise and activity. Furthermore, the results were obtained with a range of intervention approaches, including general physical therapy, exercise, cuing, treadmill, dance, and martial arts. Hence, clinicians can consider any of a range of intervention approaches when working with people with PD, especially in the early and middle stages of PD, and can take into account people’s preferences. This finding is important given that people with PD likely need to develop long-term exercise habits to sustain benefits. People are most likely to adhere to an exercise regimen if they are doing something they enjoy. Furthermore, some people may be more likely to develop sustained exercise habits if they can vary their approach. At the same time, clinicians are cautioned to consider the impairments that are most limiting to their patients when deciding which intervention approaches to use.
How Can Physiotherapy Benefit Those With Parkinsons Disease
Apart from medication and surgical procedures, it has been established that physical therapy for Parkinsons disease yields great results. Physiotherapy can benefit a patient suffering from Parkinsons in resisting the regressive changes that follow this disease and in recovering from it.
Physiotherapy can have many positive effects on patients with Parkinsons disease:
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Do Your Part Outside Of Therapy
It is vital to practice the exercises you learn in physical therapy at home. Doing exercises at home will help you reap the most benefits from physical therapy and keep you strong. Your physical therapist will show you activities that are safe for you to do outside of therapy sessions.
In addition to doing planned exercises, consider ways to increase general physical activity. For example, doing housework, gardening or walking around a store are ways to increase physical activity every day.
Four Main Symptoms Of Parkinsons Disease
As the disease progresses you might start noticing other symptoms, but at first they can be very moderate.
Other symptoms might include:
- Difficulty paying attention for a certain period of time
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Parkinson’s Disease And Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
Focus Of Pt For Parkinson’s
After collecting information about your current functional abilities and impairments, your physical therapist can start to formulate a treatment plan. Your plan of care will likely involve other healthcare professionals since PD affects so many different body systems. It is also important to include family members or friends in your treatment so that they can provide assistance if needed.
The main focus of your physical therapy should be on maintaining functional mobility and control. Specific strategies to help improve the smoothness of movement may also be necessary to maintain optimal functional mobility.
Since PD can cause many motor planning changes and mobility problems, exercise should be a primary component of treatment. The focus of exercise for PD should be to improve walking and balance, improve strength and range of motion, increase postural awareness and improve breathing and endurance. Be sure to speak with your healthcare provider and physical therapist before starting an exercise program to be sure that it is safe for your specific condition. Your healthcare provider and physical therapist can also work together to help you decide which exercises would be best suited for you.
- Carr, J. H. . Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
- Umphred, D. A. . Neurological rehabilitation. . St. Louis: Mosby.
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